In this VETgirl online continuing education blog, Dr. Garret Pachtinger reviews the coughing cat. Is it cardiac disease or respiratory disease?

Repeat after me…coughing cats are NOT cardiac!

While dogs often present to the hospital for coughing as a result of cardiac disease…our feline friends do not agree.

When I see a coughing cat I do not think of hairballs (even though pet owners commonly think their cats are coughing from hairballs). I do not think of heart disease. I think of feline asthma…especially in a young to middle-aged cat with an acute-onset of respiratory distress, notably the Siamese and Oriental breeds.

While there is no single test, tip, or tool to rapidly diagnose feline asthma, what else helps? Along with the history (e.g., does the pet owner smoke? Does the cough sound like “hacking” up a hairball? Is the coughing triggered by anything?), I first observe the patient. Not with my hands…with my eyes and ears! Just watching asthmatic cats breathe can help with the diagnosis. Cats with asthma may have an audible wheeze (which can be heard with or without a stethoscope), increased respiratory rate and effort, a pronounced “expiratory push” (or grunt).

As can be seen in this VETgirl video below, this patient with feline asthma has both an increased respiratory rate and effort as well as a pronounced expiratory push.

If the patient is stable enough for diagnostics, thoracic radiography is my go-to diagnostic (e.g., READ: Please stabilize the patient first with oxygen, sedatives, steroids and bronchodilators first!). Thoracic radiographs help to diagnose asthma based on the appearance of a bronchial or “donut” pattern. Radiographs are also helpful in ruling out other diseases such as cardiac disease, pulmonary parenchymal disease, pleural effusion, or other causes for coughing or respiratory distress.

With feline asthma, thoracic radiographs may be “normal” or may show abnormalities such as bronchial or bronchointerstitial patterns, hyperinflation, and lung lobe collapse (most frequently the right middle lung lobe).

Other diagnostics should include blood work, fecal flotation, Baermann testing, and/or Heartworm testing.

More importantly, let’s focus on treatment! While there is currently no cure for feline asthma, treatment should include bronchodilators and glucocorticoids to reduce bronchoconstriction and airway inflammation. Bronchodilators, including methylxanthines like aminophylline and theophylline or beta-2 agonists like terbutaline can be administered to cats orally or parenterally. Beta-2 agonist albuterol therapy can also be administered by metered dose inhaler. Corticosteroids can also be administered orally, parenterally, or by metered dose inhaler. The most commonly used inhaled corticosteroid is fluticasone propionate. Fluticasone propionate is a synthetic corticosteroid that has 18-fold greater affinity for the corticosteroid receptor compared with dexamethasone, the reference standard for corticosteroid potency. Don’t forget to use a space chamber like the Aerokat for administration. Your pet owners can buy these directly from Trudell or on Amazon.

A few other things to consider? Having a pet owner keep an asthma journal, so they can monitor when attacks may be occurring (e.g., secondary to spring cleaning, changes in kitty litter brands, etc.). Also, adding a HEPA Filter into the household and using a dust-free kitty litter can also help!

VETgirl ELITE members can see more on inhalers for cats HERE!

While future targets for therapy may include modulation of T lymphocyte activity, cytokine inhibition, antibody blockade, tyrosine kinase inhibition, and focus on other inflammatory mediators, for now…stick to your steroids and bronchodilators for life-saving therapy!

Dr. Garret Pachtinger, DACVECC

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